Bariatrics Program

Your weight has a significant impact on your health and overall quality of life. Bariatric surgery can
help certain patients overcome some of the challenges of weight loss. At Ocala Health, we combine
surgical expertise and the latest technology with unparalleled support from an entire team of
specialists.

Recognized as a MBSAQIP Accredited Center, we perform laparoscopic bariatric surgery options,
including roux-en-Y bypass, sleeve gastrectomy, and lap-band. With follow-up care from our team and
support from others on the same path, patients can transition to a healthy weight and a better life.

You will be admitted to the hospital about two hours prior to surgery. The surgery process takes approximately two hours; however, if you have had previous abdominal surgery, it may take longer. Family members and friends will be kept informed on how you are doing by our staff. After the surgery, you will be transferred to recovery for approximately two more hours then you will be transferred to the bariatric unit.

After you are anesthetized (“put to sleep”) on the operating table, an NG tube and a Foley (bladder) catheter are put in place. The NG tube will be removed at the end of surgery and the catheter will be removed early the next morning. You will receive your pain medications through the IV line.

If you have gastric bypass or a sleeve gastrectomy, you will have an upper GI to determine if there are any leaks at the anastomosis sites (where the intestine was cut and re-sewn). Once this is done and there are no problems, you will be started on a clear liquid diet. Lap band surgery patients will be able to start their clear liquid diet the same day as surgery once nausea subsides.

Your stomach pouch will only hold one ounce at a time; therefore, you will need to sip slowly, stopping to rest at the first sign of fullness. Remember, it will take five minutes for the liquids to empty from the small stomach pouch into the intestines. It is important to try to drink all of your liquids to prevent dehydration. Once you are able to drink enough fluids comfortably, the IV line will be removed.

If you are doing well, you may be discharged home that evening or the following day. During your discharge instructions, the nurse will schedule you for a follow-up appointment. If you have any problems consuming enough of the right kinds of fluids, we will be able to help you at that time. Feel free to call the physician's office between office visits if you have any problems or questions.

You will remain on clear liquids for one week post-operatively. You will receive a Bariatric Surgery Patient Handbook early in your work up process, which will have all the staged diets readily available to you. These are the diets that our dietician will have previously educated you on and will reinforce with you prior to discharging you home.

You will need to make arrangements to have someone bring you home from the hospital, and you will probably need minimal assistance in the home for the next couple of weeks. If surgery is done laparoscopically, you will have six to seven small incisions closed with surgical strips (or what you may know as butterfly bandages). If surgery is done as an open, the incision will extend from just under your breast bone down to the navel and is closed with stainless steel staples. The staples do not need special attention. You will be able to shower. Be sure to wash the incisions with soap, allowing the shower water to cleanse the area and then pat it dry. Wearing loose fitting clothing will be more comfortable for you during your recovery.

You will be restricted from driving until you return for your first post-op appointment. Therefore, you will need to make arrangements for someone to bring you to your first post-op office visit. Be sure to walk as much as possible once you get home. This will improve your circulation and will help prevent blood clots from forming causing a pulmonary embolism. It will also be important for you to do deep breathing exercises to prevent pneumonia.

If surgery is done open, you will be limited on the amount of activity you can do during the first six weeks. You should not do any heavy lifting (limit of five pounds), no pushing, pulling, or straining. Plan to be off from work for six weeks post-op if an open surgery is done. Depending on the type of job you do, some people feel up to returning to work part-time at three weeks post-op. An early release to work can be given with lifting restrictions.

If surgery is done laparoscopically, normal activity may be resumed in about two weeks. Many patients are able to return to work full time in one to two weeks if your job is sedentary.

Before you leave the hospital, you will be given an appointment to return to the office one to two weeks after your discharge from the hospital. If you have staples on your abdomen, they will be removed at this time. You will be given a one month appointment and then a three month appointment to monitor your diet progression, your weight loss, and your health as it relates to your weight loss. It is a vital part of your success for you to follow up at the appointed times.

At your first post-op visit, you will begin your vitamin regimen. Your food diary will be reviewed to see whether you are consuming enough protein and fluids.

You will be advised to begin your mechanical soft diet. This diet consists of foods which are very soft in texture, can be mashed on your plate, and are easy to digest. You will also be advised to begin eating three meals a day with milk or other high protein foods as a snack.

Your stomach pouch will still only hold one ounce of food at a time. The solid foods will pass more slowly than the liquids you have been consuming. It is important to learn to eat slowly, stop eating once you feel full and give time for the foods to be digested before continuing your meal. Continue to keep an occasional food record of how much and what you are eating and drinking, so we can help you with meal planning, if needed.

You will be fully able to begin a moderate exercise program. Whatever exercise you were able to do prior to surgery, you should be able to attempt now. The best form of exercise for you will depend on your physical condition and degree of obesity. Walking, stationary bikes, treadmills, and water aerobics are good places to start.

At eight weeks post-op, you will be advanced to a regular weight-reduction diet. It is very important that you continue to eat three meals a day, preferably no snacking between meals. You should be able to eat all foods except those high in sugar. Keeping a three day food record at least once a month is a good idea, to help you understand how many calories and grams of proteins you are consuming.

Your weight loss will begin to stabilize at this point. How much weight you lose each month will depend on your height, weight, age, sex, and activity level. Your eating habits will also determine how much weight you will lose. Finding a good scale that will weigh you consistently each week is difficult. Feel free to come by the office and weigh yourself. It is best to weigh yourself no more than once a week. For most people, a monthly weigh-in will be adequate.

Many patients try to compare their “success” based on how others are doing or have done. While it is important to set up friendships with other bariatric surgery patients for the emotional support and advice, remember, you can only measure your success based on how you are doing. Trying to meet or beat others' weight loss schedules will set you up for potential failure, discouragement, and despair.

You will be fully healed and can perform any work or exercise program that is within your physical capabilities. Beginning a routine exercise program is highly recommended as part of your long-term weight loss and weight maintenance program. Not only will exercise help raise your basal metabolic rate and help you to lose weight fast, it will tone your muscles. Exercise will not cause your skin to shrink back into shape.

Depending on how overweight you are, how long you have been overweight, and your age, your skin will begin to “sag” as you lose weight. Although some peoples' skin will tighten up within a year after their weight loss, most people will develop an abdominal apron or they will notice sagging skin on their upper arms, thighs, or throat. This can be corrected with plastic surgery.

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